Medicare Advantage

Medicare Advantage plans are offered through private Medicare-approved companies, which Medicare compensates for handling your benefits. With a Medicare Advantage plan, you get the same hospital and medical insurance as Original Medicare. You often have additional benefits such as prescription drug coverage, dental care, vision care, or hearing care.

What types of plans are available?

Medicare Advantage plans are commonly in the form of HMOs or PPOs. Health Management Organization (HMO) plans have networks of providers, and you will pay less if you receive service from someone in-network. With an HMO, you must have a primary care physician and need referrals to see a specialist.

Preferred-Provider Organization (PPO) plans are similar to HMOs in that they have networks of providers. You are not required to have a primary care provider, and no referrals are needed to see a specialist. These plans tend to have higher premiums due to their flexibility. You will also pay more if you see a provider outside of your plan’s network.

Private-Fee-For-Service (PFFS) plans are also available. These may or may not have a network, in which case seeing providers in the plan’s network is less costly. You can receive treatment from anyone that accepts your plan’s payment terms and do not need a primary care physician or referrals.

Special Needs Programs (SNPs) are available for specific groups of people that share a common medical condition. These plans are designed to care for the condition of its members and have a network of providers and specialists particular to that condition. These conditions are chronic illnesses such as End-Stage Renal Disease.

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How do I enroll in a Medicare Advantage plan?

There are enrollment periods designated for switching from Original Medicare to a Medicare Advantage plan, and vice versa. During the Open Enrollment Period from October 15 to December 7, you can switch from Original Medicare to a Medicare Advantage plan. You can do this if you are already enrolled in Medicare and live within the plan’s service area.

From January 1 to March 31 every year is the Medicare Advantage Open Enrollment Period (MA OEP) when you can switch back to Original Medicare and add a prescription drug plan, or you can switch to a different Medicare Advantage plan.

For all of your Medicare questions, speak with the experts at Swisher Insurance. We are trained to evaluate risk in the lives of our clients to ensure that they are given the best solutions to fit their specific situation.